title: Health care transition in young adults with type 1 diabetes: barriers to timely establishment of adult diabetes care.
abstract: OBJECTIVE
  To examine barriers to health care transition reported by young adults with type 1 diabetes and associations between barriers and prolonged gaps between pediatric and adult diabetes care.
  
  
  METHODS
  We surveyed young adults aged 22 to 30 years with type 1 diabetes about their transition experiences, including barriers to timely establishment of adult diabetes care. We evaluated relationships between barriers and gaps in care using multivariate logistic regression.
  
  
  RESULTS
  The response rate was 53% (258 of 484 eligible subjects). Respondents (62% female) were 26.7 ± 2.4 years old and transitioned to adult diabetes care at 19.5 ± 2.9 years. Reported barriers included lack of specific adult provider referral name (47%) or contact information (27%), competing life priorities (43%), difficulty getting an appointment (41%), feeling upset about leaving pediatrics (24%), and insurance problems (10%). In multivariate analysis, barriers most strongly associated with gaps in care >6 months were lack of adult provider name (odds ratio [OR], 6.1; 95% confidence interval [CI], 3.0-12.7) or contact information (OR, 5.3; 95% CI, 2.0-13.9), competing life priorities (OR, 5.2; 95% CI, 2.7-10.3), and insurance problems (OR, 3.5; 95% CI, 1.2-10.3). Overall, respondents reporting ≥1 moderate/major barrier (48%) had 4.7-fold greater adjusted odds of a gap in care >6 months (95% CI, 2.8-8.7).
  
  
  CONCLUSIONS
  Significant barriers to transition, such as a lack of specific adult provider referrals, may be addressed with more robust preparation by pediatric providers and care coordination. Further study is needed to evaluate strategies to improve young adult self-care in the setting of competing life priorities.
authors.affiliation: Division of Endocrinology, Boston Children's Hospital.
authors.forename: Katharine C
authors.initials: KC
authors.lastname: Garvey
authors.forename: Howard A
authors.initials: HA
authors.lastname: Wolpert
authors.forename: Lori M
authors.initials: LM
authors.lastname: Laffel
authors.forename: Erinn T
authors.initials: ET
authors.lastname: Rhodes
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Wolfsdorf
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
mesh_terms: D000328:Adult; D000367:Age Factors; D016001:Confidence Intervals; D003625:Data Collection; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019538:Health Care Surveys; D006282:Health Personnel / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010372:Pediatrics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin